Provider Demographics
NPI:1417933516
Name:LONGACRE, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:LONGACRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 BRENTWOOD STAIR RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3200
Mailing Address - Country:US
Mailing Address - Phone:817-507-1770
Mailing Address - Fax:
Practice Address - Street 1:1255 REESE LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-1539
Practice Address - Country:US
Practice Address - Phone:214-632-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8305207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082GXOtherBLUE CROSS BLUE SHIELD
TX047631901Medicaid
TX047631903Medicaid
TX89771NOtherBCBS
TX930078743OtherMEDICARE RAILROAD
TX89771NOtherBCBS
TX930078743OtherMEDICARE RAILROAD
TX00541QMedicare PIN
TX0082GXOtherBLUE CROSS BLUE SHIELD